• Carlos Jiménez Mascuñán, Alberto Martínez Martínez, Rosa Ríos Pelegrina, and Antonio Jesús Láinez Ramos-Bossini.
• Department of Radiology, Hospital Universitario Virgen de Las Nieves, Avda. Fuerzas Armadas, 2, 18014, Granada, Spain.
• Eur Spine J. 2024 Jul 1; 33 (7): 289228962892-2896.

BackgroundAngioleiomyomas are benign mesenchymal tumors usually located in the limbs, with anecdotal reports in the spine. We present an atypical case of an epidural spine angioleiomyoma presenting with compressive myelopathy symptoms. The diagnosis was suggested based on MRI findings, and subsequently confirmed histopathologically.ResultsThis is the first known occurrence of pure spinal epidural angioleiomyoma as a source of compressive myelopathy. The imaging presentation, especially the 'dark reticular sign' on MRI, was crucial in suggesting the diagnosis despite the atypical location CONCLUSION: This report serves to raise awareness among clinicians and radiologists about including angioleiomyoma in differential diagnoses for spinal epidural lesions with indicative MRI features. The favorable outcome after surgical intervention underscores the necessity of swift and accurate diagnosis followed by appropriate treatment for such uncommon spinal tumors.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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